Traumatic brain injury (TBI), mental health conditions (e.g., posttraumatic stress disorder [PTSD]), and vascular comorbidities (e.g., hypertension, diabetes) are highly prevalent in the Veteran population and may exacerbate age-related changes to cerebral white matter (WM). Our study examined (1) relationships between health conditions—TBI history, PTSD, and vascular risk—and cerebral WM micro- and macrostructure, and (2) associations between WM measures and cognition.

We analyzed diffusion tensor images from 183 older male Veterans (mean age = 69.18; SD = 3.61) with (n = 95) and without (n = 88) a history of TBI using tractography. Generalized linear models examined associations between health conditions and diffusion metrics. Total WM hyperintensity (WMH) volume was calculated from fluid-attenuated inversion recovery images. Robust regression examined associations between health conditions and WMH volume. Finally, elastic net regularized regression examined associations between WM measures and cognitive performance.

Veterans with and without TBI did not differ in severity of PTSD or vascular risk (p’s >0.05). TBI history, PTSD, and vascular risk were independently associated with poorer WM microstructural organization (p’s <0.5, corrected), however the effects of vascular risk were more numerous and widespread. Vascular risk was positively associated with WMH volume (p = 0.004, β=0.200, R2 = 0.034). Higher WMH volume predicted poorer processing speed (R2 = 0.052).

Relative to TBI history and PTSD, vascular risk may be more robustly associated with WM micro- and macrostructure. Furthermore, greater WMH burden is associated with poorer processing speed. Our study supports the importance of vascular health interventions in mitigating negative brain aging outcomes in Veterans.

On 15 March 2019, a white supremacist terrorist attacked two mosques in Christchurch, New Zealand. Fifty-one people were killed and another 40 sustained non-fatal gunshot injuries.

To examine the mental health of the Muslim community, and individual and exposure-related factors associated with mental health outcomes.

This is the baseline analysis of a longitudinal study of adults from the Muslim community interviewed 11–32 months after the shootings. It included a diagnostic interview (MINI), measures of sociodemographic factors, prior mental health, prior traumatic events, exposure in the attacks, discrimination, life stressors, social support and religious coping. Logistic regression models examined associations with mental health outcomes.

The sample comprised 189 participants (mean age 41 (s.d. = 13); 60% female), and included: bereaved, 17% (n = 32); injured survivors 12% (n = 22); non-injured survivors, 19% (n = 36); family members of survivors, 35% (n = 67); and community members without the above exposures, 39% (n = 74). Overall, 61% had at least one mental disorder since the attacks. Those bereaved (P < 0.01, odds ratio 4.28, 95% CI 1.75–10.49) and survivors, whether injured (P < 0.001, odds ratio 18.08, 95% CI 4.70–69.60) or not (P < 0.01, odds ratio 5.26, 95% CI 1.99–13.89), had greater odds of post-traumatic stress disorder. Those bereaved (P < 0.001, odds ratio 5.79, 95% CI 2.49–13.46) or injured (P = 0.04, odds ratio 4.43, 95% CI 1.07–18.28) had greater odds of depression.

Despite unique features of this attack on a Muslim population, findings accord with previous studies. They suggest generalisability of psychopathology after terror attacks, and that being bereaved or directly experiencing such events is associated with adverse mental health outcomes.

The study is registered on the Australian NZ Clinical Trials Registry (ACTRN12620000909921).

To reveal the chain mediating roles of insomnia and anxiety between social support and PTSD in nursing staff under the stage of COVID-19 regular pandemic prevention and control in China.

A total of 784 nurses were recruited using the convenience sampling method in Jiangsu Province, China. Demographic questionnaire, Perceived Social Support Scale, Impact of Event Scale-Revised, Generalized Anxiety Disorder-7 and Insomnia Severity Index were applied to collect data.

Social support, PTSD, insomnia and anxiety were significantly correlated with each other. Insomnia and anxiety acted as chain mediators between social support and PTSD.

Insufficient social support may trigger PTSD through the chain mediating effects of insomnia and anxiety in nursing staff under the stage of COVID-19 regular pandemic prevention and control. Measures focusing on social support, insomnia and anxiety should be taken to reduce or even prevent PTSD in nursing staff in Chinese hospitals in similar crises in the future.

This study examined the power of theory-derived models to account for the development of PTSD, Complex PTSD (CPTSD), depression, and anxiety in children and adolescents who had experienced a single-event trauma.

Children (n = 234, aged 8–17 years) recruited from local Emergency Departments were assessed at two and nine weeks post-trauma. Data obtained from self-report questionnaires completed by the child, telephone interviews with parents, and hospital data were used to develop four predictive models of risk factors for PTSD, CPTSD, depression, and Generalized Anxiety Disorder (GAD). ICD-11 proposed diagnostic criteria were used to generate measures for CPTSD and PTSD to assess for risk factors and identify the sample prevalence of these disorders.

At nine weeks post-trauma, 64% did not meet criteria for any disorder, 23.5% met criteria for PTSD, and 5.2% met criteria for CPTSD. 23.9% and 10.7% had developed clinically significant symptoms of depression and GAD, respectively. A cognitive model was the most powerful predictive model, a psychosocial model was weak, and subjective markers of event severity were more powerful than objective measures.

Youth exposed to single-incident trauma may develop different forms of psychopathology, and PTSD and CPTSD are frequently experienced alongside other conditions. The cognitive model of PTSD shows utility in identifying predictors of PTSD, CPTSD, depression, and GAD, particularly the role of trauma-related negative appraisals. This supports the application of cognitive interventions which focus upon re-appraising trauma-related beliefs in youth.

This cross-sectional study investigates the immediate psychological effects of disaster relief operations on team members following 2 consecutive major earthquakes in Turkey.

A total of 170 participants, including professional firefighters, search and rescue (SAR) workers, and volunteers, were surveyed approximately 1 month after the conclusion of active SAR operations. The study utilizes the DSM-V criteria and the Posttraumatic Stress Disorder Checklist (PCL-5) to assess symptoms of post-traumatic stress disorder (PTSD) among participants.

The findings reveal a point prevalence of 35.3% for probable PTSD, highlighting the substantial psychological impact on disaster relief teams. Factors such as age, residency in affected areas, and active SAR involvement significantly influenced probable PTSD rates. Interestingly, actively engaged SAR members had lower probable PTSD rates, possibly due to their training. Those who directly witnessed the earthquakes had higher scores, highlighting the impact of firsthand exposure. Additionally, individuals aged 50 and above displayed a higher mean total severity score compared to younger participants.

This research contributes to understanding the mental well-being of disaster relief professionals. The study’s findings underscore the importance of timely mental health support and training for these responders, emphasizing the need for preparedness in disaster relief teams.

Although several evidence-based trauma-focused treatments have been developed for post-traumatic stress disorder (PTSD), a high proportion of treatment completers fail to show total symptom or disorder-level remission. Trauma-focused treatments are predicated on the ability of one to emotionally engage with a trauma memory in order to process the traumatic experience and facilitate safety learning in the post-trauma ‘here and now’. Alexithymia, a difficulty in identifying, describing and tending to one’s emotions, occurs in approximately 40% of those who experience PTSD. This article investigates the role of emotional mechanisms in the effectiveness of trauma-focused treatments for PTSD, particularly prolonged exposure and trauma-focused cognitive behaviour therapy. Second, it explores how alexithymia poses challenges to emotion processing, undermining the effectiveness of trauma-focused treatments. The article concludes with a discussion of the clinical implications and possible treatment augmentation for those presenting with alexithymia and PTSD.

1. (1) To recognise the important affective mechanisms that can undermine trauma-focused CBT interventions.

2. (2) To widen the understanding and recognition of those who may be at risk of treatment non-response.

3. (3) To increase knowledge of available strategies and approaches in treating those who may have difficulties engaging with frontline exposure-based interventions.

Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD.

As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men.

Women reported higher PTSD severity at 3-months post-trauma. Z-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects.

Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.

Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians’ treatment choices for post-traumatic stress disorder (PTSD).

The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148).

About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct “profiles” of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines.

Clinicians’ decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.

Healthcare workers (HCWs) were considered a population at risk for developing psychiatric symptoms during the COVID-19 pandemic, such as anxiety, depression, and post-traumatic stress disorder (PTSD). Peritraumatic distress is associated with post-traumatic psychopathological symptoms; however, little is known about how it may affect functioning. The study aimed at evaluating the level of peritraumatic distress in a sample of HCWs during the first wave of the COVID-19 pandemic and at examining the relationship between peritraumatic distress, mental health symptoms, and functioning impairment.

A sample of 554 frontline HCWs were consecutively enrolled in major university hospitals and community services in Italy. The PDI, IES-R, PHQ-9, and GAD-7 were used to assess peritraumatic distress, symptoms of PTSD, depression, and anxiety, respectively, and the WSAS to investigate functioning impairment. PDI scores were higher among females, community services, physicians, and nurses. Furthermore, the PDI correlated significantly with the GAD-7, PHQ-9, IES-R, and WSAS.

In a mediation analysis, the direct effect of PDI on WSAS and the indirect effects through the PHQ-9 and IES-R were statistically significant (P < .001).

Peritraumatic distress reported by HCWs was associated with symptoms of PTSD, depression, and anxiety, but the association with reduced functioning may be only partially mediated through symptoms of depression and PTSD.

Prior research, largely focused on US male veterans, indicates an increased risk of cardiovascular disease among individuals with post-traumatic stress disorder (PTSD). Data from other settings and populations are scarce. The objective of this study is to examine PTSD as a risk factor for incident major adverse cardiovascular events (MACEs) in South Africa.

We analysed reimbursement claims (2011–2020) of a cohort of South African medical insurance scheme beneficiaries aged 18 years or older. We calculated adjusted hazard ratios (aHRs) for associations between PTSD and MACEs using Cox proportional hazard models and calculated the effect of PTSD on MACEs using longitudinal targeted maximum likelihood estimation.

We followed 1,009,113 beneficiaries over a median of 3.0 years (IQR 1.1–6.0). During follow-up, 12,662 (1.3%) persons were diagnosed with PTSD and 39,255 (3.9%) had a MACE. After adjustment for sex, HIV status, age, population group, substance use disorders, psychotic disorders, major depressive disorder, sleep disorders and the use of antipsychotic medication, PTSD was associated with a 16% increase in the risk of MACEs (aHR 1.16, 95% confidence interval (CI) 1.05–1.28). The risk ratio for the effect of PTSD on MACEs decreased from 1.59 (95% CI 1.49–1.68) after 1 year of follow-up to 1.14 (95% CI 1.11–1.16) after 8 years of follow-up.

Our study provides empirical support for an increased risk of MACEs in males and females with PTSD from a general population sample in South Africa. These findings highlight the importance of monitoring cardiovascular risk among individuals diagnosed with PTSD.